Health information technology (HIT) is now at the forefront of the health care improvement agenda because of its potential to achieve the reductions in medical errors and increases in patient safety necessary to improve clinical outcomes and efficiency. We are studying the implementation by the Lehigh Valley Health Network (LVHN) of a particular HIT application, an integrated electronic medical record (EMR) system, at its OB/GYN practice groups and the Labor and Delivery (L&D) Unit at the network's main hospital. In this process, each of the practice groups is migrating to a single, vendor-supplied, EMR, and these EMRs will be linked to a newly-upgraded system at the hospital's L&D Unit to form an integrated EMR. Once the system is installed, medical information from each physician office will be immediately available when a patient arrives at L&D, and information from a patient's visits to L&D will sent back to the office. Our goal is to use both qualitative and quantitative methods to evaluate the impact of this system, so that we can fully assess the ability of an integrated EMR to address a recognized failure to deliver accurate, complete, and timely data to physicians and clinical staff at critical clinical points along the perinatal continuum of care. We have four specific aims: Aim 1: Develop grounded theory to describe the process of effective implementation and integration of vendor-supplied ambulatory EMR systems with hospital information systems through qualitative analysis of technology acceptance and use, and complementary organizational and process changes. Aim 2: Examine quantitatively the change in data completeness (complete and accessible data) at the hospital and at the individual practices resulting from the adoption of the integrated EMR system. Aim 3: Examine quantitatively improvements in health outcomes, staff perceptions of patient safety, and patient and medical staff satisfaction, as well as changes in the productivity of primary care and inpatient physicians. Aim 4: Using mixed methods, triangulate the results of the quantitative and qualitative analyses to gain a deeper understanding of how to achieve benefits from an integrated EMR.